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i <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7 /� a <br /> (Complete in Triplicate) -- <br /> ------- ----- 3 /2-; , <br /> Date Issued -- ~--------- <br /> y -----------------------------------------_----_---- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: ) <br /> ter' :--..CENSUS TRACT=--•-•`•---- - ----------------- <br /> JOB <br /> ADDRESS/LOCATION-.-___ D _ <br /> T •i F . `-�l _- <br /> Owner's Name.----- ?"" °`� :. _ = Phone- ------E <br /> Ci <br /> Address. -- - fi! ` Zip <br /> V 4 <br /> Contractor's Name._-.__ uP�---- -- r `'`�� ti? - -Phone-.._ - <br /> . License #---- <br /> Installation will serve: _ Residence E�/ Apartment House ❑ Commercial ❑ :Trailer Court ❑ . E <br /> a r Motel ❑ Other--- f r a t <br /> Nu�mber.of living-units ' --/ -Nuniber.of bedrooms---.S-_.Garbage Grinder Lot.Size ----------- -. - ._ <br /> s <br /> Water Supply: Public System andi'name -_-__! ---- -- -.- -"_- --------------------------` ------ ------Private rE _ <br /> 1 § i <br /> Character of soil to a depth of 3 feet:3 Sand Q :Silt El 16Y F1 . Peat ❑'1 Sandy Loam E]� Clay Loam ❑ �" <br /> -Hardpan Adobe Fill Material.-.__:-------If yes,stype-----------------------Y-..-_--_ �� + <br /> (Plot plan, show.ing size of lot, location of system in relation to wells, buildings, etc. must be.placed on reverse side.) G <br /> NEW INSTALLATION:—"-'(No "septic 'tank-or seepage pit permitted if public ewer is available within 200 feet,) F <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [lf a' ` Size- ! _,-Xr __ ------------------ <br /> e <br /> "' <br /> - ----------•---- Liquid Depth r <br /> i Capacity-- ' .-----Type-- Material _ ----=:=-No. Compartments----- ---1------------------------ <br /> c ; <br /> ' Distance_to nearest:.-Well______------______ ~✓ _- Foundation 11J _.-.Prop. Line a -._- <br /> LEACHING LINE [ Na. of Lin S-- >- ,Length.of each,line-_, �1d�° `.;_ ,,•_,_Total Length.--_./' _______________'__ <br /> D' B __ ._-.T e Filter Mat ----`54 , ---Depth Filter Material".----- --------------------------------------------- <br /> ox__ - --. <br /> ,... <br /> Distance to nearest: Well-i./04W-----_--_Foundation.---.-- - ------Property Line F <br /> SEEPAGE PIT [ Depth.---;�- -Diameter_-:----- 3-------Number---. ___ _--______-- Rock Filled Yes Z-1 No❑ <br /> Water Table Depth--------- /©l ------ -----Rock Size---fl .f' -------=---- -------------- 14 <br /> _ Foundati - _-,--:Pro -._ --- <br /> Distana <br /> ceo nearesf:'Well-`, - on ---- P• Lind.. a4 <br /> f <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---------<-----------t' '`----------------- --- <br /> -------------Date---- -----------------�----- ----1 <br /> Septic-Tank (Spec ify'Requirements) --- ---=------------ -----=------------------------------------------- --- -----------I--------- --- --------- -- ------------�­--- , <br /> Disposal Field.(Specify Requirements)-------------- ----- I------=---------'---- ----- - = = -------------- =-----.---------------_--- <br /> r k ------ _. ----- ----------------- <br /> ---------------------------------------- <br /> - ----------- =------------- --- --- <br /> I ------------------------------ <br /> (Draw <br /> --------- - <br /> ---------------- -------------------- -- ----- ------------ ----------------------------- ------- <br /> ' ¢ ' (Draw existing and required addition on reverse side) <br /> f I hereby certify 1hat:11 have prepared this application and that:the work will.-be. done in accordance with San Joaquin County <br /> Ordinances, State Laws, and. Rules-and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 1- signature certifies the following: ` <br /> t "I certify that in'the pei-formance of.the'work'for which this 'Permit- s issued, I shall not employ"any person in such manner asf <br /> t to become subiect to Workman's C mos C pensation laws of ryCalifornia.'.' - w -- <br /> - 4 <br /> Signed-=------= -- ------------------- ---- •----y------...- - Owner,- <br /> gY ------------=------=------------------- _ = ------- ) <br /> p "M � . <br /> 'LTi}Ie __�.�Jc. +-�c <br /> Vf other than owners _ T <br /> FOR DEPARTMENT ELSE ONLY <br /> APPLICATION ACCEPTED BY, ------------ = - ------------------------DA 7 <br /> TE' <br /> DIVISION OF LAND NUMBER.- - ------ ---- ------ ---=- -- --------- DATE <br /> ADDITIONALCOMMENTS------------------ - -----------------:-------------=------------------- ------ ----------------- ---------------------------------------- ---------------------- <br /> --------------------------- ------------------ <br /> - ---------------------------------------------- <br /> i. <br /> ---------------------------------- --- -- - <br /> I -- <br /> Final-inspection-by:'-"`_ =- =' � =----------------'�'�' ate.w-:� <br /> EH 13 24 SAN.JOAQUI LOCAL HEALTH DISTRICT5�1677 REV. 7176 3M <br />